Non-U.S. Import Health Certificate Sample

der Nederlanden

Koninkrijk

GEZONDHEIDSCERTIFICAAT
certificaatnummer:
(veterinair certificaat)
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Koninkrijk der Nederlanden
Ministerie van Landbouw,
Natuur en Voedselkwaliteit

Kingdom of the Netherlands
Ministry of Agriculture, Nature
and Food Quality

Nederlandse Voedsel- en
Warenautoriteit

Netherlands Food and
Consumer Product Safety
Authority

Königreich der Niederlande
Ministerium für Landwirtschaft, Natur und
Lebensmittelqualität
Niederländische Behörde für
Lebensmittel- und
Produktsicherheit

Gezondheidscertificaat

Health Certificate

Gesundheitsbescheinigung

Royaume des Pays-Bas
Ministère de l’ Agriculture, de
la Nature et de la Qualité des
Aliments
Autorité néerlandaise de
sécurité sanitaire de
l'alimentation et des produits
de consommation
Certificat Sanitaire

Reino de los Países Bajos
Ministerio de Agricultura
Naturaleza y Calidad
Alimentaria
Autoridad holandesa de la
seguridad Alimentaria y de los
Productos de consumo
Certificado Sanitario

VETERINARY CERTIFICATE FOR THE EXPORT OF GELDINGS FROM THE NETHERLANDS
TO THE UNITED STATES OF AMERICA
I.

IDENTIFICATION OF THE HORSES

Product no.

Name of the horse*

Product no.

Sex

II.

Identification no.

Breed

Distinctive markings

Color

Date of birth

ORIGIN OF THE HORSES

Product no.

Name and address of the premises of residency immediately prior to export

Product no.

Name and address of the premises of origin

Name and address of the exporter
Port of embarkation
III.
DESTINATION OF THE HORSES
Means of conveyance
Identification of the means of
conveyance
U.S. Port of arrival/Entry point
Name and address of the consignee

:
:
:
:
:
:

IV.
HEALTH ATTESTATION
This is to certify that on _____________ (date), I examined the horse identified above:
1.
The horse was in the country of export for the last 60 days immediately preceding exportation to the
United States(1). If residing in the country for less than 60 days, the horse is accompanied by a like
health certificate issued by a salaried veterinary officer of the national government of each country in
which the horse has been during the 60 days immediately preceding shipment to the United States,
with the residency dates spent in each country specified(2);
2. Has been inspected and found to be free of contagious diseases and, insofar as can be determined,
not exposed to communicable diseases immediately preceding exportation, or if applicable, during the
indicated period of residency in any of the countries listed;
3. Has not been vaccinated with a live, attenuated or inactivated vaccine during the 14 days immediately
preceding exportation;
4. Has not been on premises where African horse sickness, dourine, glanders, surra, epizootic
lymphangitis, ulcerative lymphangitis, equine piroplasmosis, equine infectious anemia (EIA),
contagious equine metritis (CEM), vesicular stomatitis, or Venezuelan equine encephalomyelitis has
occurred during the 60 days in the countries where the horse has resided immediately preceding
exportation, nor have these diseases occurred on any adjoining premises during the same period of
time;
5. Has been examined and found to be free of ectoparasites.
Document ref. : NVWA_CLH_VE_B_US_paard_ruinen_EN_0.2_certificaatmodel

certificaatnummer:

Page 2 of 2

Notes:
*
Clear identifications must accompany this certificate: photographs, microchip, and/or a silhouette indicating
markings. A passport identifying the horse may be attached to this certificate provided that the passport number is
included.
(1)
The health certificate from the final country that the horse resides in immediately prior to export must be endorsed
by the examining veterinarian and the salaried veterinary officer of the national government of the country of
export or can be endorsed solely by the salaried veterinary officer of the national government of the exporting
country if they are also the examining veterinarian.
(2)
If the horse is residing in a European Union member state other than the member state of export during the 60
days immediately preceding shipment to the United States, then the horse can be accompanied by a like health
certificate issued by an examining veterinarian of each member state, with the residency dates spent in each
member state specified.

Gedaan te / Done at / Ausgefertigt in / Fait à / Hecho en
Op / On / Am / Le / El
Handtekening officiële dierenarts / Signature of the official veterinarian /
Unterschrift des amtlichen Tierarztes / Signature du vétérinaire officiel /
Firma veterinario oficial

Naam in hoofdletters / Name in capital letters / Name in Grossbuchstaben /
Nom en lettres capitales / Nombre en letras capitales

Document ref. : NVWA_CLH_VE_B_US_paard_ruinen_EN_0.2_certificaatmodel